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17TH ANNUAL PHARMACEUTICAL and MEDICAL DEVICE COMPLIANCE CONGRESS Office of Inspector General Update

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17TH ANNUAL PHARMACEUTICAL and MEDICAL DEVICE COMPLIANCE CONGRESS Office of Inspector General Update 17TH ANNUAL PHARMACEUTICAL AND MEDICAL DEVICE COMPLIANCE CONGRESS Office of Inspector General Update Mary E. Riordan, Senior Counsel Office of Counsel to the Inspector General October 19, 2016 AGENDA FOR TODAY Update on recent enforcement activity Update on OIG reports and other publications Lessons/suggestions for consideration ISSUES IN RECENT SETTLEMENTS Settlements addressed a variety of areas: Kickback issues Marketing and sales issues Medicaid drug rebate program issues Drug price reporting issues FALSE CLAIM ACT SETTLEMENTS Kickback-related settlements Salix Pharmaceuticals, Inc. Olympus Corporation of the Americas Novartis Pharmaceuticals Warner Chilcott Omnicare, Inc. FALSE CLAIM ACT SETTLEMENTS Settlements involving sales and marketing issues Acclarent, Inc. Genentech Inc. and OSI Pharmaceuticals LLC Paradigm Spine Qualitest Pharmaceuticals Settlement involving Medicaid drug rebate issues Wyeth/Pfizer Settlements involving other issues Imported and compounded drugs CIVIL MONETARY PENALTY SETTLEMENTS Drug Price Reporting CMP Settlements Nephron Pharmaceuticals Corporation Cipher Pharmaceuticals US, LLC Coloplast Corp. OIG REPORTS Drug pricing issues “Average Manufacturer Prices Increased Faster Than Inflation for Many Generic Drugs” – December 2015 (A-06-15-00030) 340B program issues “Part B Payment for 340B Purchased Drugs” - Nov. 2015 (OEI-12-14-00030) “State Efforts to Exclude 340B drugs from Medicaid Managed Care Rebates” – June 2016 (OEI-05-14- 00430) OIG REPORTS Reports relating to the Medicaid Drug Rebate Program Reviews of the collection of Medicaid rebates for physician-administered drugs – KS, UT, WY, SD, MT, CA Other issues “FDA Is Issuing More Postmarketing Requirements, but Challenges with Oversight Persist – July 2016 (OEI-01- 14-00390) OIG FY 2016 WORK PLAN Planned work includes Medicare Part B drug pricing review Reviews of price increases for Medicare Part D covered drugs Medicaid drug rebate-related reviews 340B drug pricing program review NEW AND NOTEWORTHY April 2016 – Criteria for implementing permissive exclusion under Section 1128(b)(7) of the SSA Supersedes and replaces prior 1997 notice Reflects lessons learned from OIG’s experience Reflects widespread development of compliance programs Under the new criteria, OIG uses a risk spectrum to evaluate whether to pursue exclusion. LESSONS/SUGGESTIONS Maintain a focus on kickback issues A continued area of focus in cases/settlements Open Payments database Think broadly – payments and transfers of value Risk areas from recent cases: Speaker programs Arrangements with specialty pharmacies Equipment loans, free equipment LESSONS/SUGGESTIONS Importance of individual accountability Law enforcement focus on responsible individuals Think about accountability in compliance Certifications from Boards of Directors Management certifications Compliance as a component of employee evaluations Disciplinary action for compliance failures LESSONS/SUGGESTIONS Effective compliance programs remain the goal Basic compliance program elements are expected Modifications in recent CIAs Compliance programs/CIAs should be tailored to address risk areas Compliance program must continuously evolve Importance of risk assessment and mitigation QUESTIONS? .
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